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Gender bias in the halls of medicine?

Going to medical school is no guarantee for women doctors that they’ll break through the glass ceiling, it seems. A new study by the University of Michigan Health System uncovered a $12,000-a-year gap between what male and female doctors earn in one of medicine’s most rarefied areas – research and academia.

The researchers compared men and women who were mid-career physician researchers and found they weren’t paid equally, even though they did comparable work. Over the course of a 30-year career, the difference amounted to $350,000.

The report’s publication this month in the Journal of the American Medical Association comes on the heels of a new report by the University of Minnesota on the persistent gap in what women earn compared to men.

What makes the JAMA study especially notable is that it’s among the few to compare apples to apples. The researchers controlled for specialty and for hours worked. They also adjusted for academic rank, leadership positions and research time – and still came up with a disparity. Nor did the pay gap seem to be influenced by whether the female physician-researchers were raising children, because it persisted even among women who weren’t mothers.

A couple of factors may help explain some of the differences in pay: The female physician-researchers in the study held fewer of the top positions that command higher pay. They also were less likely to be in the higher-paying medical specialties.

It’s not clear whether this was the result of institutional bias, and addressing this question was outside the scope of the study. Perhaps it simply indicates this group of women didn’t pursue leadership positions in academic medical research or that they were less likely to choose higher-paying medical specialties.

The findings from the JAMA study are not isolated. A 2010 study by the Mongan Institute for Health Policy at Massachusetts General Hospital came up with almost the same conclusion: Women in academic medicine make less money, even when differences in work hours, research, teaching, patient care and other professional activities are taken into account.

It all raises the issue: Is there gender bias within the medical profession?

Once upon a time, women weren’t admitted to medical school. In a doubling-down of sexist attitudes, it was presumed that if they wanted a career involving patient care, they could become nurses.

Women who were the first to break through this barrier didn’t face an easy time of it. Dr. Susan Love, well known as a surgeon and outspoken advocate for breast cancer prevention, has spoken often about the obstacles she faced in medical school in the 1960s. There were virtually no female surgeons so she had few role models or mentors. And because she’s a surgeon who’s both female and gay, it “meant that I was never going to be accepted into the ‘old boys club,'” she says. “It meant that I had to be better and I had to serve my patients so well that they would come to me for that reason and not because someone had referred them.”

At the time, between 5 and 10 percent of students entering medical school were female, and quotas were imposed to give these women a chance. These days, women are represented in far greater numbers. According to figures from the Association of American Medical Colleges, 47.3 percent of new medical school applicants in the fall of 2011 were female.

They’re not distributed equally across specialties, though. Women tend to cluster in certain areas – pediatrics, internal medicine, family medicine, obstetrics/gynecology – and gravitate less often toward some specialties such as orthopedic surgery or neurosurgery that continue to be dominated by men and often are higher-paying.

Despite the strides made by women in medicine, it may not be enough. More recently, female enrollment in medical school has declined, for reasons that remain unclear. Are women becoming disenchanted with the prospect of the high stress and long hours that accompany a career in medicine? Have women with undergraduate degrees in the sciences found better opportunities in fields other than medicine?

Even the public tends to think of doctors in terms of “he” rather than “she.”

It’s the goal of most industries, including medicine, to have a diverse workforce. Indeed, a culturally and gender-diverse physician workforce is seen as one way of helping reduce the ethnic and economic disparities in health that persist in the United States. To be sure, there are medical schools, research institutes, hospitals and medical practices that back this wholeheartedly in their hiring and pay policies. But if it isn’t modeled – and supported – as widely as possible in the medical teaching and research institutions where students are molded into doctors, it’s hard to see how any meaningful progress can be achieved.